CERTIFICATE

The Schengen Travel Insurance

This document is provided by Inter Partner Assistance, a member of the AXA Assistance Group and has been generated from
http://www.axa-schengen.com

With the present document, Inter Partner Assistance covers the following traveller:

First name: NILA JOSSETH

Last name: LOPEZ PROANO
Date of birth : 12/09/1972
Nationality: ECUADOR
Passport n°: 1711746758

In case of a medical incident, this insurance covers the traveller in all countries of the Schengen Area, in Switzerland and in
Lichtenstein, for the following:

- emergency medical care, emergency hospital care, surgical fees, transportation, repatriation for medical reasons, repatriation
in case of death and medications.

A ceiling of 30 000 (thirty thousand) Euros in the Schengen area, Lichtenstein, San Marino, the Principalities of Andorra and
Monaco and Vatican City and its equivalent in Swiss Francs, US Dollars and Pounds Sterling (at official rate of exchange on
the date of occurence of the incident) for medical claims occurring and treated in Switzerland or involving an insured whose
country of residence is the United States of America or the United Kingdom for the period insured.

Reference of the policy Low Cost

Policy no.: SCHLC2019-29936-A

Date of subscription: 08/06/2019

Period covered: from 16/07/2019 to 15/08/2019.

Drawn up in Brussels on 08/06/2019

For the attention of Embassies and Consulates - ONLINE verification

In order to strengthen the security, Embassies and Consulates can check the validity of the present certificate by
entering the following information on the Internet site:

http://www.axa-schengen.com/embassy/

Name of beneficiary: LOPEZ PROANO

Policy no.: SCHLC2019-29936

AXA Schengen follows strictly the Regulation (EC) No 810/2009 of the European Parliament and of the Council of July 13th of
2009, implemented on April 5th of 2010. In all cases, the covered period refers to this insurance policy only and its validity. It
can't be used as an argument when applying for visa.

In case of a medical incident, contact AXA Assistance 24/7

via telephone: +32 2 552 53 98 or via email: be.med@ip-assistance.com

Inter Partner Assistance immediate solutions

Public limited company with registered capital of EUR 8.396.373
Avenue Louise 166 B1 - 1050 Brussels -Belgium
BIC : BBRUBEBB - IBAN : BE49 3100 7270 0071 Tel : +32 2 550 04 00
Insurance company authorised under no. CBFA 0487,
registered in Belgium at the Brussels Chamber of Commerce under no. 0415.591.055.